Characteristics and trends in incidence of childhood cancer in Beijing,China,2000-2009

Objective： To investigate the characteristics and incidence trends of childhood cancer in Beijing, China, from 2000 to 2009. Methods： A total of 1,274 cases with childhood cancer in Beijing from 2000 to 2009 were included in the study. All rates were age-standardized using the direct method to the world standard population and expressed per million person-years. Incidence trends were characterized by calculating annual percent change （APC） usingJoinpoint Regression Program. Results： The crude incidence rate was 106.47 per million [age-standardized rate （ASR） 113.34] between 2000 and 2009 in Beijing with the most common diagnoses, leukemia （N=505, 39.64%, ASR 45.20）, followed by central nervous system （CNS） tumors （N=228, 17.90%, ASR 19.28） and lyrnphoma （N=91, 7.14%, ASR 6.97）. The incidence for all childhood cancers combined has increased during the study period, with an APC of 5.84% [95% confidence interval （95% CI）： 1.0-10.9] after adjusted by world population. The ASR of all combined cancers in boys showed a slight, but no significant increase, with an APC of 5.33 % （95 % CI： -0.6- 11.6）; for girls, the trends increased significantly, with an APC of 6.54% （95% CI： 1.5-11.8）. Conclusions： The incidence rate of childhood cancer in Beijing was higher than the average level of China and lower than that of western countries. The incidence trends of childhood cancer, especially leukemia among girls showed a significantly increase from 2000 to 2009. While among boys, no substantially change was seen during the observed time period. Some sex-specific trends by subcategories and trends of major cancers in different age groups by cancer site merit further investigation.

Male fertility following childhood cancer: current conceptsand future therapies

<abstract>Prepubertal boys treated for cancer may exhibit impaired fertility in later life. A number of chemotherapeu tic agents have been identified as being gonadotoxic, and certain treatment regimens, such as that used for Hodgkin's disease, are particularly associated with subsequent infertility. Radiotherapy may also cause gonadal damage, most notably following direct testicular irradiation or total body irradiation. Because of the varied nature of the cytotoxic insult, it can be difficult to predict the likelihood of infertility in later life. Currently it is not possible to detect gonadal damage early due to the lack of a sensitive marker of gonadal function in the prepubertal age group.Semen cryopreservation is currently the only method of preserving fertility in patients receiving gonadotoxic therapy. This is only applicable to postpubertal patients and can be problematic in the adolescent age group. At present there is no provision for the prepubertal boy, although there are a number of experimental methods currently being investigated. By harvesting testicular tissue prior to gonadotoxic therapy, restoration of fertility could be achieved following treatment, either by germ cell transplantation or by in vitro maturation of the germ cells harvested. Alternatively, rendering the testes quiescent during cytotoxic treatment may protect the germ cells from subsequent damage. In addition to the many scientific and technical issues to be overcome prior to clinical application of these techniques, a number of ethical and legal issues must also be addressed to ensure a safe and realistic prospect for future fertility in these patients.

Clinical characteristics of childhood cancer in emergency room in a tertiary hospital in Pakistan

INTRODUCTION Worldwide, cancer is an important cause of mortality in children aged over 1 year. Numerically, the major cancers include acute lymphoblastic leukemia, CNS tumors and lymphomas. Cancer incidence is increasing in children globally as well as in Pakistan but the etiology is poorly understood. There are an estimated 160 000 new cases and 90 000 deaths per year worldwide in children aged under 15 years.The exact incidence in Pakistan is not known as there is no national tumor registry

Exploratory Study of Intolerance of Uncertainty and Its Cognitive Processes by the Stroop Task among Parents of a Childhood Cancer Survivor

Introduction.No study has examined the relationship between the factor of intolerance of uncertainty and its effects on the cognitive processes among parents of a childhood cancer survivor.Intolerance of uncertainty is a central factor in generalized anxiety disorder;an anxiety disorder in which impaired processing of cognitive information in the form of cognitive biases is also observed.The aim of the study was to measure,via a classical Stroop test and an emotional Stroop test,the orientation of selective attention in relation to the uncertainty intolerance factor.Methods.61 parents of a childhood cancer survivor(aged 4 to 6 years)were recruited from hospitals in the Province of Liege(Belgium).Parents completed questionnaires on intolerance of uncertainty and its associated factors(i.e.,usefulness of worry,cognitive avoidance,problem-solving attitude,and ruminations)and performed a Stroop test and an emotional Stroop task.Spearman correlations and multiple linear regressions were performed.Results.The results indicated positive and significant correlations between the emotional Stroop(negative interference index)and intolerance to uncertainty but also with repetitive thoughts(ruminations)and worries.Linear regressions showed that depressive symptoms seem to contribute to explaining longer latencies for the interference condition(color word written in another color).Conclusion.Recommendations have been published to improve the management of parents of a childhood cancer survivor,but parent-centered neuropsychological studies are still needed and should be developed to improve prevention and detection initiatives for these families.

Muscle strength deficits are associated with low bone mineral density in young pediatric cancer survivors:The iBoneFIT project

Background Pediatric cancer survivors are at increased risk of muscle weakness and low areal bone mineral density(aBMD).However,the prevalence of muscle strength deficits is not well documented,and the associations of muscle strength with aBMD are unknown in this population.Therefore,this study aimed to investigate the prevalence of upper-and lower-body muscle strength deficits and to examine the associations of upper-and lower-body muscle strength with age-,sex,and race-specific aBMD Z-scores at the total body,total hip,femoral neck,and lumbar spine.Methods This cross-sectional study included 116 pediatric cancer survivors(12.1±3.3 years old,mean±SD;42.2%female).Upper-and lower-body muscle strength were assessed by handgrip and standing long jump test,respectively.Dual‑energy X‑ray absorptiometry was used to measure aBMD(g/cm2).Associations between muscle strength and aBMD were evaluated in multivariable linear regression models.Logistic regression was used to evaluate the contribution of muscle strength(1-decile lower)to the odds of having low aBMD(Z-score≤1.0).All analyses were adjusted for time from treatment completion,radiotherapy exposure,and body mass index.Results More than one-half of survivors were within the 2 lowest deciles for upper-(56.9%)and lower-body muscle strength(60.0%)in comparison to age-and sex-specific reference values.Muscle strength deficits were associated with lower aBMD Z-scores at all sites(B=0.133–0.258,p=0.001–0.032).Each 1-decile lower in upper-body muscle strength was associated with 30%–95%higher odds of having low aBMD Z-scores at all sites.Each 1-decile lower in lower-body muscle strength was associated with 35%–70%higher odds of having low aBMD Z-scores at total body,total hip,and femoral neck.Conclusion Muscle strength deficits are prevalent in young pediatric cancer survivors,and such deficits are associated with lower aBMD Z-scores at all sites.These results suggest that interventions designed to improve muscle strength in this vulnerable population may have the added benefit of improving aBMD.

Childhood Cancer Less Common in Twins

笔者本人是孪生姐妹之一,我的孩子也是一对龙凤胎,所以,我对这条有关Twins的消息便特别有兴趣。文章的主题句“拎”出本文要义,而且给了一个百分比:Twins experienced some 20％ fewer childhood cancers than expected。人类对自身的认识尚处在初级阶段,文章承认:Why twins are less likely todevelop cancer in childhood remains a mystery。但是,研究人员有自己的分析,你同意吗?】

Psychometric properties of the Chinese version of the Parent Perception of Uncertainty Scale(PPUS)among parents of children with cancer diagnosis

Objective:Parents of children diagnosed with cancer often experience high levels of illness uncertainty.This study evaluated the psychometric properties of the Chinese Version of the Parent Perception of Uncertainty Scale for Childhood Cancer(PPUS-CC)in China's Mainland.Methods:Exploratory factor analysis(EFA)and confirmatory factor analysis(CFA)were performed using study population of 420 parents.The participants were also given the social support questionnaire and assessed using the Self-Rating Anxiety Scale,Zarit Burden Interview,and Self-Rating Depression Scale to test the association with PPUS-CC and obtain the cut-off of the scale.Results:The Chinese version of PPUS-CC includes 14 items,and two factors were extracted by EFA,which could explain the 54.56%variances.The Cronbach'sαof two factors ranged from 0.830 to 0.877.The dimensions of PPUS-CC show statistical association with other scales,and the cut-off is 42.5.Conclusion:The Chinese version of PPUS-CC,as a reliable,valid,and easy-to-use clinical tool,can be adapted in clinical settings as a screening tool to recognize parents with high-risk psychological problems.

Cardiovascular risk management in cancer survivors:Are we doing it right?

Although under-recognized,cancer survivors continue to be at an increased risk of death from cardiovascular complications post-remission or cure.This increased burden of cardiovascular disease results from the interplay of various factors.Adequate cardiovascular risk assessment and timely intervention through a multi-disciplinary approach in these patients plays a pivotal role in the prevention of cardiovascular morbidity and mortality.We discuss the shortcomings of using current risk prediction scores in cancer survivors and provide some insights into cardiovascular risk management relevant for primary care physicians,oncologists,and cardiologists alike.

Effects of dual sofosbuvir/daclatasvir therapy on, chronic hepatitis C infected, survivors of childhood malignancy

BACKGROUND Childhood cancer survivors are potentially at a higher risk of infection with hepatitis C virus (HCV).The effects of all-oral direct-acting antiviral therapy (DAA) on both the HCV infection as well as the state of cancer remission have not been well investigated in this population.AIM To test the effects of dual sofosbuvir/daclatasvir (SOF/DCV) therapy in the treatment of chronic HCV in survivors of hematologic malignancy in pediatric age group.METHODS We conducted a prospective,uncontrolled,open-label multicenter study.A total of 20 eligible,chronic HCV,genotype-4,infected children who had been in continuous complete remission from hematologic cancer (leukemia/lymphoma) for at least one year were included in the study.All patients were treated with combined SOF/DCV for 12 wk.Patients were monitored throughout the study till 12 wk after end of treatment for safety and efficacy outcomes including the sustained virologic response 12 (SVR12) rate,hematological indices,liver and kidney functions.RESULTS The intent-to-treat SVR12 rate was 20 of 20 (100%;95%CI: 84%-100%).All patients showed normalized liver enzymes from week-4.All hematological indices,liver and kidney functions were kept normal throughout the study.No fatalities or treatment-emergent serious or severe adverse events were reported throughout the study.CONCLUSION SOF/DCV combined therapy could be used safely and effectively in the treatment of chronic HCV genotype-4 infection in leukemia/lymphoma treated children.No relapses were detected during treatment and throughout the follow up period for either the original malignant disease or the HCV infection.

Radiation Exposure and Cancer Incidence (1990 to 2008) around Nuclear Power Plants in Ontario, Canada

Radiation doses and cancer incidence among the population living within 25 km of three nuclear power plants (NPPs) in Ontario, Canada were investigated for the period 1985 to 2008 for radiation exposure and 1990 to 2008 for cancer incidence. This study design provided at least a five-year latency period between potential radiation exposure and cancer incidence. Around the NPPs, the incidence of childhood cancers, leukemia and non-Hodgkin lymphoma, in young children (aged 0 - 4) was lower than the general Ontario population, but not statistically so. Cancer incidence in children aged 0 - 14 was similar to the Ontario population. Overall, for all ages there was no consistent pattern of cancer incidence (all cancers combined and radio-sensitive cancers) across the population living within 25 km of the three NPPs. Some types of cancers were statistically higher than expected, others were statistically lower than expected, and others were similar to the general Ontario population. Although variations in all cancers combined and radiosensitive cancers were found in this study, the pattern was found to be within the natural variation of cancer in Ontario. During the period 1985 to 2000 (Pickering and Bruce NPPs) and 1985 to 2002 (Darlington NPP) radiation doses to members of the public from the operation of the NPPs, estimated on the basis of a hypothetical individual at the facility fence line, were ≤0.052 mSv/year;while for the period 2001 to 2008 (Pickering and Bruce NPPs) and 2003 to 2008 (Darlington NPP) radiation doses, more realistically estimated using the critical group concept for six age classes, were ≤0.0067 mSv/year. Hence, public doses from environmental releases of radionuclides from Ontario NPPs represent a very small fraction of natural background radiation (1.338 and 2.02 mSv/year) in the regions where the NPPs are located. Our study shows no evidence of childhood leukemia clusters around the three NPPs and that the incidence of all the cancers investigated for all age groups is within the natural variation of the disease in Ontario. The radiation exposure from NPP operation is a small contributor to the public’s total exposure to radiation and is not a plausible explanation for any excess cancers observed within 25 km of any Ontario NPP.

儿童神经母细胞瘤预后列线图的开发和验证

目的:研究儿童神经母细胞瘤患者的临床特征及预后因素,并构建列线图预测患者的预后。方法:回顾性分析美国SEER数据库2004~2016年诊断为神经母细胞瘤的2 312例患者资料,采用R软件构建列线图来预测患者总生存时间(OS)和癌症特异生存时间(CSS)。使用一致性指数(C-指数)、曲线下面积(AUC)、校准曲线和决策曲线分析(DCA)对列线图的预测性能进行评估,并对1年、3年和5年的OS和CSS进行了校准。结果:多因素分析显示年龄、原发部位、分级、SEER分期、手术和化疗是儿童神经母细胞瘤患者预后的独立危险因素,基于上述因素绘制的列线图具有较好的准确性(OS的C-指数=0.778,AUC=0.824;CSS的C-指数=0.801,AUC=0.836)。此外,校准曲线显示列线图预测的1年、3年和5年的OS和CSS概率与实际生存率有着良好的一致性。结论:年龄、原发部位、分级、SEER分期、手术和化疗是儿童神经母细胞瘤患者预后的独立危险因素。本研究构建的预后列线图可以用于预测儿童神经母细胞瘤患者的预后情况,为患者个体化治疗提供参考。

儿童恶性肿瘤的环境危险因素研究进展

恶性肿瘤是影响儿童身心健康的重大疾病之一。有关儿童恶性肿瘤的环境危险因素主要包括物理因素、化学因素、生物因素以及因个体对外界刺激的敏感性不同而形成的个体易感性差异。本文从这4个方面综述了目前儿童恶性肿瘤环境病因学方面的研究现状,为开展儿童恶性肿瘤的病因学研究提供更全面认识,从而采取有效的预防措施,减少有害因素的暴露。

恶性肿瘤患儿家庭功能及影响因素分析

目的探讨恶性肿瘤患儿的家庭功能及影响因素。方法采取整群随机抽样方法,抽取北京市4家、唐山市4家三级甲等医院内就诊的白血病、脑瘤、淋巴瘤等恶性肿瘤患儿的母亲或父亲280名为研究对象,采用Feetharn家庭功能量表(feetham family functioning survey,FFFS)进行调查。结果 FFFS各条目按实际与期望差异分和重要分排序,均位于前列的分别是"孩子具有的问题"(3.40±1.90)和"不能工作的时间"(3.20±1.94);FFFS各维度的实际与期望差异分由高到低排序依次为家庭与社会的关系(2.18±1.05)、家庭与个体的关系(1.22±0.89)和家庭与家庭内亚系统的关系(0.98±0.72);影响恶性肿瘤患儿家庭功能的因素是家庭月收入>5 000元和患病时间>3年(P<0.05)。结论恶性肿瘤患儿的家庭功能低于正常家庭,家庭的社会功能(家庭与社会的关系)发挥较差,孩子的健康问题是家庭的主要问题。

儿童肿瘤患者治疗及长期生存质量的研究进展

肿瘤是儿童时期严重威胁儿童生命健康的重要疾病之一,但随着儿童肿瘤治疗手段的不断完善及发展,儿童肿瘤患者的长期生存率在不断提高,长期生存者的数量也在不断增加。与此同时,肿瘤治疗相关的远期并发症及不良影响越来越受到关注,长期生存者的生存质量也逐渐成为不容忽视的问题。本文主要针对儿童肿瘤的放射性治疗、化学药物治疗、手术治疗、造血干细胞的移植治疗等方式及对长期生存者生存质量管理进行综述,并对治疗前景进行展望。

恶性肿瘤患儿治疗期间营养风险及营养状况的纵向调查

目的调查与评估肿瘤患儿从诊断到治疗6个月期间的营养风险和营养状况;比较淋巴瘤与实体瘤患儿的营养状况。方法回顾性分析2019年7月至2021年11月北京儿童医院肿瘤中心肿瘤内科收治的76例初发恶性肿瘤患儿的营养状况。测量化疗前、化疗后1个月、3个月及6个月时的体重、身高和上臂围;采用儿童肿瘤营养风险筛查工具(SCAN)对此4个时间点行营养风险筛查并评估营养状况;调查4个时间点的24 h膳食摄入及血常规;通过病历收集化疗后1个月的并发症及治疗6个月期间的营养治疗情况;比较淋巴瘤(43例)与实体瘤(33例)两组患儿的营养状况。结果76例患儿化疗前营养不良发生率15.8%(12/76),化疗后1个月32.9%(25/76),3个月25.0%(19/76),6个月26.3%(20/76),4个时间点之间差异有统计学意义(P<0.001)。化疗前超重/肥胖率10.5%(8/76),化疗后1个月7.9%(6/76),3个月5.3%(4/76),6个月6.6%(5/76),4个时间点之间差异有统计学意义(P=0.044);营养不良评分、体质指数(BMI)、上臂围、血红蛋白、前白蛋白、营养风险筛查评分和总能量摄入在4个时间点之间差异均有统计学意义(P<0.001);化疗后3个月内变化大,化疗后1个月营养状况最差。两组比较:化疗后6个月淋巴瘤组和实体瘤组营养不良评分[(0±0.9)分比(-0.5±0.9)分]、BMI[(15.9±2.1)kg/m^(2)比(14.8±2.2)kg/m^(2)]、上臂围[(17.4±2.0)cm比(16.2±2.9)cm]、SCAN分数[1(1,9)分比2(1,9)分]、血红蛋白[(103.0±15.0)g/L比(94.2±13.5)g/L]、营养不良例数[7例(16.3%)比13例(39.4%)],淋巴瘤组均优于实体瘤组,差异有统计学意义(P<0.05)。结论鉴于采用高强度方案化疗的儿童营养状况不容乐观,应强化营养筛查和评估,及早发现有营养风险的患儿,积极干预,提高患儿对化疗的耐受性和生命质量。

Fertility preservation for female patients with childhood and adolescent cancer

With the significant cancer treatment in the past decades,>85%of children with cancer now survives into adulthood,and fertility preservation has become an important quality-of-life technology for them.1 Cancer treatment may include surgery,chemotherapy,radiotherapy,and/or hematopoietic stem cell transplantation(HSCT).2 Except for non-pelvic surgery,these treatments may affect ovarian function and consequently cause varying degrees of gonadal toxicity.3 Patients cured by anti-cancer treatment have a very high risk of premature ovarian insufficiency(POI).

环境因素的宫内暴露与生后致癌的研究进展及预防策略

恶性肿瘤是危害人类生命与健康的最严重疾病。近些年,恶性肿瘤发病率的明显变化特点之一就是年轻化趋势,其中儿童和青少年癌症的发病率上升较快,已引起各国学者的广泛关注。一些学者认为,这可能主要与母亲在怀孕期,甚至怀孕前期对各种致癌性环境因素暴露有密切的因果关系。人群流行病学调查或动物试验结果显示,在孕期胎儿或胎仔宫内暴露于射线、烟雾、一些药物、酒精、农药、有机溶剂、重金属、某些病毒感染等环境危险因素,与生后诱发肿瘤有相关性。尽管许多环境危险因素的宫内暴露致癌作用还缺乏相应的人类资料和确切依据,但随着社会经济的发展,人类接触各种环境危险因素的机会越来越多,由于一些环境因素的宫内和孕前暴露而导致其子女诱发肿瘤的潜在风险还在不断增加。因此,当务之急是大力开展环境因素的宫内暴露与子女诱发肿瘤相关的病因学研究,不断发现新的环境危险因素。同时,鉴于胎儿对各种环境致癌因素作用的高敏感性,在怀孕前期和孕期阶段,积极采取有效措施消除其环境危险因素,对降低儿童乃至全民肿瘤发病率具有重要意义。

基于结构方程的心理弹性模型在肿瘤患儿父母群体中的构建

目的探讨肿瘤患儿父母心理弹性模型(Resilience in Illness Model,RIM)的构建。方法采用便利抽样法抽取229名在中山大学附属肿瘤医院接受治疗的肿瘤患儿的父母,使用探索性潜变量的结构方程(SEM)以及逻辑回归对肿瘤患儿父母的心理弹性进行因子分析。结果初步建立的RIM结构方程具有良好的拟合度,其中5个主要的影响因素是父母应对方式、负性情绪、疾病不确定感、父母文化水平、患儿肿瘤诊断分型,共能解释70%的心理弹性变量。结论 RIM增加了我们对心理弹性这个概念的理解,通过对RIM的进一步完善,可能为今后提出相应的干预措施提供理论指导。

恶性肿瘤患儿父母心理韧性的质性量化研究

本研究以78位恶性肿瘤患儿父母为研究对象,采用质性与量性研究相结合的方法收集资料,关注其自孩子发病后的心理韧性的内涵及特点。通过对质性数据的量化处理,共提炼出3个主题,11个亚主题以及318个不同的1级编码,其中3个主题分别为"成为一个合格的父亲/母亲"、"努力使自己保持希望"和"活在当下的积极应对",分别占总编码的46.9%、29.6%和23.5%。其中"努力成为一个合格的父母"是肿瘤患儿父母心理韧性的重要来源之一,临床医护人员及时的肯定与赞许可以帮助父母完成这一角色。

儿童肿瘤生存者父母营养知识问卷的编制及信效度检验

目的编制适用于儿童肿瘤生存者父母的营养知识问卷,并检验其信效度。方法以肿瘤生存者营养指南和国内外膳食指南为指导,通过文献分析、小组讨论、德尔菲法、预调查,形成问卷初稿,并对220名儿童肿瘤生存者父母进行调查,检验正式问卷信效度。结果儿童肿瘤生存者父母营养知识问卷包括5个维度,35个条目,问卷Cronbach’sα系数为0.888,折半信度为0.828,重测信度为0.741,内容效度指数为0.930;各维度Cronbach’sα系数为0.687~0.792,折半信度为0.617~0.724,重测信度为0.747~0.814,各条目内容效度指数为0.818~1.000。探索性因子分析共提取5个公因子,累积方差贡献率为41.70%。结论该研究形成的儿童肿瘤生存者父母营养知识问卷具有良好的信效度,可用于评估儿童肿瘤生存者父母营养知识水平,为护理人员开展营养干预提供指导。